AMY ELISABETH SUPAK Dietitian and Nutritionist License verification

Business Entity

NOT RENEWED

License Type

Dietitian and Nutritionist

Description

LICENSED DIETITIAN NUTRITIONIST

License Number

164001131

License Status

NOT RENEWED

Business

First Name

AMY ELISABETH

Last Name

SUPAK

Business Name

AMY ELISABETH SUPAK

Original Issue Date

12/06/1995

Effective Date

10/17/2019

Expiration Date

02/28/2022

City

PEORIA

State

Zip

61656

County

PEORIA

Ever Disciplined

LastModifiedDate

07/27/2022